Organization
SOUTHCENTRAL FOUNDATION
Active
Parent organization
SOUTHCENTRAL FOUNDATION
Other names
BSD-ICM
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHCENTRAL FOUNDATION
Authorized official
RONALD LEE OLSON (EXECUTIVE VICE PRESIDENT FINANCE)
(907) 729-4939
Entity
Organization
Contact information
Practice address
400 W BENSON BLVD, ANCHORAGE, AK 99503-3829
(907) 729-2500
Mailing address
PO BOX 35198, SEATTLE, WA 98124-5198
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1697415
—
AK
Enumeration date
01/09/2019
Last updated
09/14/2023
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